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Month: September 2017

As I now close in on 190 hours of facial electrolysis, I look back on my naive optimism from two years ago.

Still a long ways to go,* although these days I rarely shave as long as I’m getting two hours of work done each week.

But the remaining hair is pretty translucent, making it hard for my electrologist to find, so I have to let it grow longer . Thankfully, it’s not terribly visible, but the feel of it — and the gender dysphoria it triggers — isn’t much fun.

* Hoping that I’ll be finished up in another six months or so. It’s a triumph of hope over experience, since my “stubborn Viking hair” as she calls it, is not giving up without a considerable fight.

This time last year, I was a bit of an emotional wreck as I felt my masculine self slipping away. Obviously, it’s something that I desired, but at the same time there was a tangible and acute sense of loss and grieving that’s incredibly hard to describe. I could not be who I am today without his decades of self-sacrifice, and willingness to step aside for me. So I offer my gratitude once again:

Thank you for the gift of my life. I love you so very much. I will always cherish and protect your memory, and this soul you’ve given me. As I delight in this increasingly feminine body, I think warmly of you. You may not have ever fathered a child, but you were a loving brother and father-figure to your sister who is now taking her place in the world.

You have done so, so much for me. You will always be a part of me, and I will always honor your life and respect your journey. Now your journey’s end is in sight. As the days count down, I sense you fading into me, subsuming yourself, growing fainter. Sweet surrender… well, more like bittersweet surrender. But more sweet than bitter.

Enjoy your soon-to-come retirement. You did an exceedingly hard job, you did it well, you did it until you couldn’t any more. You deserve peace, rest and comfort.

I’d like to think he’s off enjoying his retirement, drink in his hand, toes in the sand, on some beach somewhere. Gone, but definitely not forgotten.

I know people probably have questions about bottom surgery, after yesterday’s post, so I wanted to shed light on something that’s probably pretty mysterious for most cisgender people. I will talk about some specifics of the procedure and its recovery, but hopefully not in a way that will squick people out. Nonetheless, if you’re squeamish, you might want to sit this one out.

OK, so what is bottom surgery? For trans woman, it’s creating a vagina and vulva out of male genital tissue. It’s not cut off, it’s reused. (I’ll talk about trans men later.) It’s commonly been referred to as sexual reassignment surgery, or more recently, gender confirmation surgery a term I’m personally not fond of because I know my gender identity regardless of what pink bits I have. The antiquated term, “sex change,” is one to avoid using.

Why go to Thailand? Short answer: If you were re-arranging the furniture, wouldn’t you want to go to the best surgeon you can find? While there are some excellent surgeons in the U.S. (and more surgeons are learning the procedure), surgeons in Thailand are usually using a technique that’s more advanced (the Thais have been pioneers in this field). Generally the results have better aesthetics, are better at retaining sensation, and involve a single surgery, rather than two months of surgery several months apart. The trade-off is that it’s a tougher recovery because more work is being done at once.

Does it look “natural” and perform “naturally”? Yes, definitely. (Trust me I’ve looked a more than my fair share of post-surgery pics when doing research.) Obviously there are some scars, most notably along the creases of the leg, but after healing, they’re surprisingly invisible. As far as the second question, usually you end up with the same depth as a factory-installed version, however it is a bit less stretchy, and some more adventurous forms of penetration are probably off the table. However, it doesn’t really self-lubricant to same degree, so lube is a must. Also, state the obvious, no, it doesn’t menstruate — one aspect of womanhood, I’m happy to miss out on — although it can it vulnerable to yeast infections, etc.

How do they do it? Contrary to popular lore, they don’t cut it off, rather the tissue is reused. The “penile inversion” technique that’s widely used in the U.S. is exactly what it sounds like: They essentially turn the penis inside out, strip away unneeded tissue — e.g. the erectile tissue — and reform that into a vagina and clitoris, as well as reroute the urethra into the proper location. Dr. Suporn invented the “Chouburi Flap” technique, now used by other Thai surgeons, which does things somewhat differently and places a premium on “mapping” tissue to it’s equivalent place, e.g. the foreskin and glans are similar tissue to that of the inner labia, so it’s used to create them. The technique also emphasizes making sure the appropriate levels of sensation are in the right place, e.g. the vulva is more sensitive than the vagina, and that the vagina uses more sensitive tissue near the opening and less further back (just like the factory-installed version). If there’s not enough genital donor tissue, then they may use skin grafts from other parts of the body. I’m not sure if it’s part of the Chonburi Flap technique per se, but Thai surgeons are adapt at stripping away the layer of skin (dermis) of scrotal tissue where the hair follicles are, eliminating the for genital electrolysis <shudders> pre-surgery. Either is necessary to prevent hair from growing inside the neo-vagina.

How long does it take to recover? With Dr. Suporn, you’re there for a month post-surgery, before you fly home. You need the time to physically recover, and he can fix any problems that might develop. (Usually they’re minor, but there can be some nasty complications if the some area don’t get enough blood supply and develop tissue necrosis.) After that, one really should take at least another 2-4 weeks before returning to work. As you might imagine, sitting can be uncomfortable for quite a while. Surgeons will give you a special pillow. But the worst part of it is dilation — insert a medical dildo to neo-vagina from closing during the first two weeks, and later on to prevent scar tissue from contracting, and yes, it hurts as much as it sounds like. Imagine trying to insert an oversized dildo (even though the dilators aren’t that large) and then pushing it hard against the back of your vagina at least 15 minutes, 3x/day for the first 2-3 months post-surgery, 2x/day for another 3 months, 1x/day for another 6 months. After a year all the healing is finished, although one still needs to do it 2-3 times a week (for the rest of your life), although… other things, ahem… can be substituted for the dilators. If there are problems after 12 months, Dr. Suporn offers one round of revision surgery for free — although you have to pay your way back to Thailand for it.

Do many trans people regret it? No, it’s only around 1-2% — much lower than almost any other kind of plastic surgery. In part that’s because — for better or worse — there is a lot of gatekeeping involved. Typically you need two psychologists/psychiatrists to sign off before surgeons will operate. Some of that is CYA on the surgeon’s part, they don’t want someone to sue because they ended up unhappy after an irreversible operation. Partly it’s just a smart thing to make sure your head is straight first. Honestly, I think the vast majority of people, trans or cisgender, would be wise to do some therapy before getting any form of major plastic surgery for their own benefit, since there’s number of people who get it done for reasons they later regret. (Reputable surgeons will screen for this, even for something as routine as a nose job.) But yes, it also raises huge issues about body autonomy, particularly in the bad old days, when fuckability was quite literally a criteria some surgeons used to determine who they’d operate on.

Does insurance cover it? Complicated question. Technically, yes. California is one of the states that requires insurance companies covers bottom surgery. (Usually insurers specifically prohibit coverage for any other trans-related surgery, and yeah it sucks, and many trans people can’t afford to do it out of pocket. Doesn’t make them any less trans for not doing so.) In practice though, it can be hard to get insurers to cover it if you go outside the U.S. You have to pay upfront and hope that they’ll reimburse you, which often times they never get around to doing. Which is particularly annoying because the Thai surgeons are less expensive, and usually have shorter waitlists.

What about trans guys? I admittedly only have a high-level knowledge about their procedures (trans guys feel free to chime in!), but here goes. There’s a greater a variety of techniques from ones that simply free the clitoris from it’s surrounding tissue, since if a trans man has been on testosterone, that often causes the clitoris to grow into a small penis (they’re both actually made of the same tissue), so freeing it makes it look more penis-like. The most ambitious technique is a phalloplasty, which reconstructs tissue to form a penis. That said, bottom surgery options for trans men are usually far more expensive than trans women, and the results less satisfactory. Partly, because as one surgeon put it, it’s easily to make a hole than a pole. Partly because there’s simply been less research into better techniques. So many trans men opt to skip bottom surgery,and just do “top surgery” to remove their breasts. Doesn’t make them any less trans for not doing so.

Thanks to health problems during the first half the year, I’ve procrastinated getting all my name changes done. Today was one of the easier ones… Called the water company, they just asked me to verify last four digits of my social security number and my date of birth. Done! Wish they could all be this easy.

Finally got on the calendar for having bottom surgery about a year from now, with the one of best surgeons in the world for that operation, who’s retiring in mid-2019.

Lots of feels — it’s a mixture of excitement and “holy fuck, what I am doing?!” (it’s a demanding surgery physically, I’ll be in Thailand for a month for the immediate post-surgical recovery, the after-care takes over your life for the better part of year, and yeah, I’d be radically changing my body).

Lots of self-examination coming up to make sure I truly want to do it. Fortunately, I’m not one of those trans people who feels like their genitals are some sort of alien appendage. OTOH, I’d feel much more congruent with an innie rather than an outie.*

But given circumstances, it makes sense to at least get a date reserved, since he’s fully booked for the next 1-1/2 years until his retirement date.

* TMI warning: Contrary to popular lore, no they don’t cut it off, rather they quite literally turn things inside out, and then reshape the analogous tissue to match its counterpart in female genitalia. (We’re all born with the same materials in our genitals, it just gets shaped differently depending on which sex-related hormones we’re exposed to in the womb.) And yes, the result looks and performs like a factory-installed model — this surgeon in particular is known for the quality of his results in that regard.

To borrow a line from Helen Boyd’s essay: I am and always was Jolie Laide;* it just took some effort to make that visible. Need to refer to me “before”? Use Jolie Laide 1.0.

Yes, I sometimes refer to my pre-transition male persona by the name I was assigned at birth, when I need to talk about that aspect of me. He was very real part of me, but not the real me. The best analogy is how Method actors create a character that may be very different than their off-stage self, but it’s drawn still drawn from aspects of their own personality.** Just as my stage persona that’s a larger than life version of my muggle self.

(FYI, “Dead naming” is referring to someone by the name they used prior to transitioning, usually the name they were assigned at birth.)

* Yes, Jolie Laide, is a nom de plume. It allows me to be freer about talking about intimate things here, and with bigots doxxing trans people, I prefer to keep a bit of separation between here and my offline self.

** And yeah, I also find it a bit weird to talk about myself in the third-person, but it’s a convenient shorthand.